Substance Use Disorder Treatment Model

Substance use is a complex issue with many facets and a wide variety of approaches have been tried with varying degrees of success. Southcentral Foundation has developed an approach that differs from more standard treatment in significant ways. Where many traditional approaches to substance use treatment require that participants stop escaping from their lives through abstinence, while simultaneously hoping they will create a life from which they no longer want to escape, SCF’s approach refrains from this and instead works to empower customer-owners to improve their lives.

SCF’s treatment approach is called the Path to Healthy Living model. The model is strengths-based, culturally-focused, and tailored to customer-owners. It respects and responds to the whole person in context of their health needs, values, cultural preferences, family, community, etc. The model is evidence-informed, combining the Indigenous Medicine Wheel model of wellness with Motivational Interviewing, Solution-Focused therapy, Cognitive Behavioral Therapy, Acceptance and Commitment, and other integrative techniques.

The Path to Healthy Living model’s central philosophy is that substance use is a symptom of an underlying problem and that anyone addicted to a substance relies on use as a primary coping strategy to deal with something in life. Providers must respect that substance use makes sense in the context of the person’s life and do so by focusing first on addressing the underlying need substance use currently meets before ever asking the person to give up
their only coping strategy, no matter how maladaptive it has become. The model focuses on creating a life where the individual wants to remain present, sober, and engaged, and where the individual no longer feels the need to escape or use maladaptive coping behaviors of any type. The goal is neither abstinence nor moderation, but rather wellness as the individual defines it.

Rather than focusing on managing triggers and problematic behaviors, the Path to Healthy Living model focuses on motivating goals that are rooted in individual’s values. It works to build supporting activities and behaviors to move closer to life goals. Strategies to manage detour behaviors are learned, but the core focus is on moving closer to goals, not reducing detours.

The model also offers other types of support for customer-owners. For example, support is offered for other medical appointments, getting an identification card from the Department of Motor Vehicles, getting a medical alert device, etc. Other activities such as skill groups and resume-building are also available.

Incentives are offered for participants during the first 16 weeks of treatment through the Contingency Management Program. These incentives are based on engagement and attendance rather than abstinence. Points are used to spin a wheel with a chance of a prize, and participants can select from a variety of items such as toys, clothes, hobby crafts, books, and more. NIDA/NIH research has shown that incentive-based behavioral therapy along with psychosocial therapy is more effective than psychosocial therapy alone.

The overall goal of the Path to Health Living model is to provide participants with new ways to understand substance use, with motivation, and to create the conditions for beneficial change. The model seeks to help participants to become more aware of themselves, what they are experiencing, and their values so that they can create goals based on those values and make progress toward them.

The approach has enabled SCF to build relationships with those impacted by substance use, reduce barriers to engagement, and increase community awareness of support available. SCF has been encouraged by the response from customer-owners and employees. For more information about the Path to Healthy Living model, or any other aspect of SCF’s Nuka System of Care, feel free to contact the SCF Learning Institute.